Medicare Audit Defense

A Medicare audit letter
is not a final verdict.

RAC, UPIC, and MAC audits are increasing for dermatology practices — especially those billing Mohs, skin substitutes, and SRT. Master Billing provides pre-audit risk assessment, full audit response management, and ALJ appeals representation to protect your revenue.

The Audit Escalation Ladder
STEP 1 Initial demand / overpayment notice
STEP 2 Redetermination (MAC level)
STEP 3 Reconsideration (QIC level)
STEP 4 ALJ Hearing — highest reversal rate
Audit Types We Defend

Every audit type,
every level of appeal.

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RAC (Recovery Audit Contractor)

Automated and complex medical review of claims submitted within the last 3 years. High frequency for derm practices billing Mohs, skin substitutes, and E/M services. We respond with clinical documentation packages designed to withstand technical and clinical scrutiny.

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UPIC (Unified Program Integrity Contractor)

The most serious audit type — UPIC investigations can lead to prepayment review, program exclusion, and referral to OIG. We provide documentation alignment audits before they request records and manage the full response process if a UPIC investigation begins.

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MAC Targeted Reviews

Medicare Administrative Contractors conduct periodic targeted reviews of high-utilization codes. Dermatology practices are regularly targeted for Mohs, skin substitutes, and biopsies. We conduct proactive LCD compliance checks to reduce targeting probability.

Our Defense Approach

Pre-audit, during audit,
and appeal.

Most billing vendors only help after you've already received a demand. We provide three layers of protection — reducing the probability of audit targeting, managing it when it happens, and winning at the appeal stage if needed.

Pre-audit risk assessmentWe analyze your claim history for patterns that match current CERT and OIG target areas — and fix them before they trigger a review.
Documentation alignmentWe align your clinical documentation to coding standards so every record supports the claim exactly as submitted.
ADR response managementWe prepare complete Additional Documentation Request responses with clinical narrative, supporting records, and payer-specific formatting.
Redetermination & reconsideration appealsWe draft and submit MAC-level redeterminations and QIC reconsiderations with full clinical justification packages.
ALJ hearing preparation & representationWhen prior levels fail, the ALJ stage offers the highest reversal rates — and we prepare every case to succeed there.

Received an audit notice?
Don't respond alone.

Every day you wait is a day closer to their deadline. Contact us today — we'll review your situation and tell you exactly where you stand.